Cardiovascular Disease comprises of an inter-related spectrum of diseases that affect the heart including coronary artery disease, angina, myocardial infarct (heart attack) and heart failure. Hypertension (high blood pressure) is also included within this category but shall be covered elsewhere.
What is Coronary Artery Disease?
With Coronary Artery Disease, increasing levels of atherosclerotic plaque are laid down within the arteries of the heart slowly blocking these vessels such that blood flow to associated heart tissue is restricted. Coronary Artery Disease is commonly caused by the oxidation of cholesterol and related chemicals as a result of increased stress on local tissues. This may occur secondary to the effects of smoking, low anti-oxidant protection, the influence of inflammatory mediators upon blood vessels, the implications of high blood sugar levels due to Insulin Resistance or Diabetes and environmental influences such as heavy metals.
What is a ‘Heart Attack’?
An heart attack occurs when there is insufficient blood for the heart to function properly. With the gradual closure of blood through heart vessels, more strain is placed on the heart. Additional to the slow artery occlusion, fragments of plaque may break off closing the artery entirely nd preventing blood from accessing the tissues it feeds. Furthermore blood vessels may spasm (called 'vasospasm') due to inappropriate muscular contraction, also occluding the artery.
Where blood is limited angina (heart pain) may result. This is a variable pain that may occur from chin to abdomen, elbow to elbow. It can also feel like an intense pressure on the chest wall. Unfortunately, episodes can also be silent, leading to repeated damage before a problem is diagnosed.
If blood restriction is significant enough, death of heart tissue may result. As the heart tissue scars rather than heals, this leads to a deterioration in heart function with the potential to develop chronic heart failure. Where severe heart tissue death occurs, the person themselves may die as a result.
Do you have Chronic Heart Failure?
Additional advice specific to this condition is provide by clicking on this link.
What are the Risks?
The eight most commonly cited risks for heart disease are:
1. Family History
3. High Blood Pressure
5. High Cholesterol
6. High Homocysteine
A growing body of evidence also links Coronary Artery Disease to a pro-inflammatory environment that encourages the oxidation of cholesterol in the arteries. Therefore it is essential that you manage any other Medical Conditions you have to reduce your risk of Cardiac disease.
In particular, managing Diabetes, High Blood, Pressure and Depression are critical when trying to limit your cardiac risk. 80% or more of Diabetics will die of a cardiac related disease.
You should therefore follow the advice in the Medical Conditions section for each of these conditions (much of which will overlap for general Lifestyle Medicine) to get these under control. These conditions will also determine which Healthy Eating Plan you should follow.
So what about my Diet?
This is very important.
In the instance that you have Diabetes, High Blood Pressure or Depression you should follow the Healthy Eating Plans discussed under these conditions. If you do not have Diabetes, High Blood Pressure or Depression you are encouraged to follow an Insulin Resistance Healthy Eating Plan..
If you have other Medical Conditions associated with the immune system such as an autoimmune disease (e.g. Rheumatoid Arthritis) then you are encouraged to follow the Immune Enhancing Healthy Eating Plan (in the absence of Diabetes risk factors).
A further alternative is a Vegetarian approach as advocated by the Ornish Programmes. It may be a great way of kick starting your new cardiac plan, although it depends upon your commitment to this style of eating. Over the long term (> 6 months) you may need to monitor your protein, Vitamin B12 and iron status, particular if you feel increasingly fatigued.
Should I Lose Weight?
As obesity is an important cardiac risk factor, losing weight is important.
As has been explained elsewhere, the health of your gastrointestinal system is vital to all other body systems. A Food Elimination Regime, used to identify possible food intolerances (which serve to create a pro-inflammatory environment) is also a great kick-start to losing weight.
You may then try one of the Eating Plans as suggested by your Medical Condition. Alternatively, find a formularised weight loss programme (diet/exercise) you are comfortable with, preferably supported by peers.
If neither are effective, consider discussing weight loss with a Doctor who may examine some of the hidden causes of unsuccessful weight loss that may include Thyroid Disease, Adrenal Exhaustion, Hormone Imbalances (Oestrogen Dominance), undiagnosed Diabetes or Insulin Resistance and so forth, with associated nutrient insufficiencies that are leading to further resistance against weight loss.
Also consider whether Emotional or Compulsive Eating are preventing your compliance with weight loss programmes. These may also be linked with Neurotransmitter imbalances that need to be worked with if you are to be successful.
What are the Cardiac Superfoods?
Additional to the reputed benefits of generalised diet principles, studies have indicated that specific foods may also decrease the risk of cardiac events. For instance, a recent study noted the following risk reduction from eating particular foods:
FoodQuantity Risk Reduction Serve Equivalent
Wine 150ml/day 32% 2 glasses/day
Fish 400g /week 14% 4 X 100g/ week
Dark Chocolate 100g/day 21% 100g > 70% Chocolate
Vegetables and Fruit 400g/day 21% 5+ 2
Garlic 2-7g/day 25% 1 teaspoon fresh
Almonds 68g/day 12.5% Shallow cupped palm
Cumulative All Listed 76%
Franco et al. The Polymeal: a more natural safer and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75% BMJ 2004 Dec 18;329(7480): 1447-50
There are other foods also claimed to have cardiac preventative benefits, although in some cases, the evidence is not as well established.
Oats, Barley, Whole Grains, Soy Products, Carrots, Lentils/Beans, Handful Mixed Tree Nuts, Onions, Capsicum, Alfalfa Sprouts, Apples, Bananas, Grapes, Cherries, Blueberries, Raspberries, Eggplant, Broccoli, Ginger, Unsweetened Yoghurt, Selected Margarines.
What effect can Food Intolerances have?
Given many food intolerances may increase the inflammatory mediators in the body, the risk is they may also accelerate the oxidation of cholesterol. Therefore, we advise you to reduce your intake of foods you are intolerant to, even if included above as a "Superfood".
What about Fats in particular?
If you follow any of the Eating Plans you will minimise your intake of unhealthy fats, either through limiting saturated fat or trans-fats intake that are produced from high heat cooking. The more foods you consume that are fresh or lightly cooked (salads, soups, steamed, stir fry, grilled), the better.
As for butter versus margarine, limiting your use of foods that require either is the best place to begin, for most people will also add a sugar laden spread to whatever they have ‘buttered.’. There is some evidence for the effectiveness of specific phytosterol rich margerines.
As for dairy, the volume argument holds true here, too. If you are only consuming one serve of dairy in a day, do not be overly concerned to go no or low fat as there are valuable fat soluble vitamins in dairy. However, if you are consuming more than this, then consider low fat varieties on most occasions (information regarding the Dairy Dilemma is available at the Osteoporosis Healthy Eating Plan page).
What about Cholesterol?
There are certainly debates in complementary circles regarding cholesterol as cholesterol itself is necessary for creating many important hormones. Furthermore, cholesterol needs to be oxidised to become harmful and therefore it may be just as important to provide anti-oxidant protection as to drive cholesterol down.
Thus we find that eating a diet high in fruit and vegetables and hence anti-oxidants has been found to have twice the cardio-protective effect as lowering cholesterol specifically.
This being said, lowering cholesterol is implicit in all the Healthy eating Plans. A shallow handful of nuts per day can be effective in lowering cholesterol. Eggs may also have a effect on cholesterol, however, this may be either positive or negative. You must be careful as a sub-group of people do appear to egg-responsive; that is, their cholesterol does increase on an high egg diet. Red meat and full cream dairy may also have a cholesterol raising effect.
What other Nutrients may a Practitioner recommend?
There are various other nutrients/herbs that may be recommended independently or in combination with a pharmaceutical approach. Always ensure, by discussing with your practitioner, whether there are any drug-nutrient-herb reactions you need to be aware of.
EPA/DHA Fish Oils are effective for two main reasons. The EPA component reduces inflammation and the oxidation of cholesterol. The DHA component assists in preventing the excess smooth muscle contraction that may reduce the diameter of cardiac blood vessels independent of atherosclerosis.
Plant phytosterols, including those found in some functional Margarines, are thought to have a beneficial effect on reducing cholesterol. However, the doses recommended are often far more than you would achieve from a Margarine spread unless you are consuming very high amounts of spread-requiring foods. Different forms of plant sterol supplements are also available.
Vitamin E is a powerful anti-oxidant that may break down atherosclerotic plaque, although clinical results have been mixed, including what dosage is required, as well as whether too much may be detrimental to cardiac risk. A quality Vitamin E supplement is required as there are many synthetic varieties that simply may not work.
Vitamin C as an anti-oxidant has been theorised to assist prevention of atherosclerotic plaque build up as well as break down existing formation. Studies are limited but are mainly positive with doses starting at 250mg/day.
Policosanols (sugar cane wax alcohol) have been demonstrated to lower cholesterol in animal studies yet there is insufficient human evidence to presently suggest they are effective. very large doses are required.
Similarly mixed results have been indicated for the use of Selenium supplementation in Cardiac Disease, considered to contribute significantly to the anti-oxidant response.
Magnesium is helpful in inducing smooth muscle relaxation, particularly when supported by Taurine and the B Group Vitamins.
The amino acid, Arginine, may be helpful where angina (heart pain) is related to vasospasm of the heart vessels. Arginine helps relax the smooth muscle tissue by reversing the influence of nitric oxide. Caution if you also suffer with the herpes virus.
What is Homocysteine and is it important?
Homocysteine is part of a fundamental chain of events that occurs in the body’s biochemistry. When homocysteine is increased, various medical risks exist including an increase in Cardiac Disease. Unfortunately many practitioners fail to adequately address Homocysteine.
If fasting homocysteine is raised it generally indicates a deficiency in Folate, Vitamin B6 and/or Vitamin B12. Although their effectiveness in reducing cardiac risk is yet to be tested, we suggest supplementing with the above nutrients for 3 months. Betaine hydrochloride and/or SAMe may also be suggested under the supervision of a practitioner.
How about High Dose Vitamin B3 (Nicotinic Acid)?
This has been found to reduce the risk of heart disease, cardiac events and long term survival. Problem is, at the doses required for specific effect many people suffer significant side effects. Not to be recommended at present unless under medical supervision.
Are there any Herbs that are Recommended?
In particular, Hawthorn is known to exert various beneficial effects on cardiac function. However, most of the clinical evidence is specifically directed towards its importance upon Cardiac Failure, a condition that differs to Coronary Artery Disease.
As inflammation may induce atherosclerotic plaque formation, the anti-inflammatory herbs, Garlic, Ginger and Turmeric are also often prescribed for Coronary Artery Disease. Effective supplementation often requires concentrated or extracted formulas to be effective in other medical conditions and the same is likely to be true for Cardiac Disease.
Is Exercise Important?
Exercise is essential to Cardiac Health. The main exercise to focus on is, unsurprisingly, aerobic or cardiovascular exercise. You should exercise at least 30-60 minutes per day 5 or more days per week using a form of exercise that is intense enough to make you short of breath.
If you have recently had a cardiac event you should join a cardiac rehabilitation programme and have your exercise monitored. Furthermore, your doctor needs to give you clearance to exercise after an event. Rarely is exercise contraindicated, simply modified to your needs.
Smoking? The answer's Obvious
This is probably the most significant change you can make in your life if you are a smoker. If you cannot quit without assistance, this being the majority of smokers, it may be sensible to join a multidisciplinary programme. Peer support is often essential to the success of any quit smoking plan.
Remember, although pharmaceutical approaches that replace nicotine via chewing gum, patch or otherwise are often helpful, eventually they must be weaned otherwise you may simply be trading the risk of lung cancer for other diseases.
Stress, Life Balance, Emotional Intelligence, Spirituality
As Depression is now indicated as a potential risk factor for Cardiac Disease, anything that deals with your mental health may be an advantage, as will specific treatments focused on Depression.
Such interventions may include:
Relaxation and Meditation independent or as part of a Yoga programme
Other Effects Based Stress Managements techniques
Cause Based Stress Management Techniques
Achieving Work Life Balance
Learning to effectively manage Emotions
Prioritising Family and other Relationships (including healing old wounds)
Becoming connected with your community, environment and, if you are spiritual, the concept of God/Universe that matters to you.
Spare a Thought for your Teeth
Available evidence also suggests a link between Cardiac Disease and periodontal conditions, possibly due to the effects of chronic low grade infection upon atherosclerotic development in heart vessels. If you have any ongoing dental problems, have them resolved. Integrative dentists tend to avoid root canal therapy and do not use mercury amalgums for fillings.
Addressing heart health often involves a multi-disciplinary approach to other Medical Conditions and Lifestyle Modification. Be realistic - there are many factors you can change but you may need to prioritise them if you are to remain motivated over the long term to lifestyle modification.